The Effect of a Couples Intervention to Increase Breast Cancer Screening Among Korean Americans

Abstract

Purpose/Objectives To assess the efficacy of Korean Immigrants and Mammography—Culture-Specific Health Intervention (KIM-CHI), an educational program for Korean American (KA) couples designed to improve mammography uptake among KA women. Design A two-group cluster randomized, longitudinal, controlled design. Setting 50 KA religious organizations in the Chicago area. Sample 428 married KA women 40 years of age or older who had not had a mammogram in the past year. The women and their husbands were recruited from 50 KA religious organizations. Methods Couples were randomly assigned to intervention or attention control groups. Those in the KIM-CHI program (n = 211 couples) were compared to an attention control group (n = 217 couples) at baseline, as well as at 6 and 15 months postintervention on mammogram uptake. Main Research Variables Sociodemographic variables and mammography uptake were measured. Level of acculturation was measured using the Suinn-Lew Asian Self-Identity Acculturation Scale. Researchers asked questions about healthcare resources and use, health insurance status, usual source of care, physical examinations in the past two years, family history of breast cancer, and history of mammography. Findings The KIM-CHI group showed statistically significant increases in mammography uptake compared to the attention control group at 6 months and 15 months postintervention. Conclusions The culturally targeted KIM-CHI program was effective in increasing mammogram uptake among nonadherent KA women. Implications for Nursing Nurses and healthcare providers should consider specific health beliefs as well as inclusion of husbands or significant others. They also should target education to be culturally relevant for KA women to effectively improve frequency of breast cancer screening.

Korean American Women and Mammogram Uptake

“…Therefore, we analyzed pre-intervention data from the Korean Immigrants & Mammography-Culture-specific Health Intervention (KIM-CHI), a large randomized controlled trial focused on improving mammography adherence among non-adherent KA women, to compare sociodemographic factors and health beliefs about BC and screening between adherent and non-adherent KA women [32]. Based on the American Cancer Society's recommendations for annual mammograms for women aged 40 and older [33], we defined non-adherent to be if one had not been screened within previous year of data collection.…”

Health behaviour change interventions for couples: A systematic review

“…The sample size ranged from 39 couples (Burke et al ., 1999) to 3,839 (Øien, Storrø, Jenssen, & Johnsen, 2008). The studies were carried out in the USA (Cohen et al ., 1991; Lee et al ., 2014; Manne et al ., 2013; McBride et al ., 2004; Robinson, Turrisi, & Stapleton, 2007; Voils et al ., 2013; Wing, Marcus, Epstein, & Jawad, 1991), Australia (Burke, Giangiulio, Gillam, Beilin, & Houghton, 2003; Burke et al ., 1999), the United Kingdom (van Jaarsveld, Miles, Edwards, & Wardle, 2006), Israel (Benyamini, Ashery, & Shiloh, 2011), South Korea (Park, Song, Hur, & Kim, 2009), Germany (Gellert, Ziegelmann, Warner, & Schwarzer, 2011), and Norway (Øien et al ., 2008). …”

“…The interventions varied considerably in intensity, from an invitation to screening (van Jaarsveld et al ., 2006), to a 16‐week programme focusing on health behaviours (Burke et al ., 1999, 2003). Length of follow‐up varied from a single visit post‐intervention where measurements were taken (e.g., blood pressure, heart rate; Burke et al ., 1999) to 15 months (Lee et al ., 2014). This information is reported in Table 1.…”

“…Only six of the 14 studies reported carrying out a power calculation (Benyamini et al ., 2011; Burke et al ., 1999, 2003; Lee et al ., 2014; Park et al ., 2009; Voils et al ., 2013). Some of the remaining studies may have been underpowered (e.g., Wing et al ., 1991).…”

“…Similarly, an RCT of a couple‐based educational programme about breast screening for Korean Americans who had not had a mammogram in the past year led to increased uptake of mammograms at 6 months ( p  < .001) and 15 months ( p  = .004) relative to a couple‐based educational programme about having a healthy diet (Lee et al ., 2014). However, an RCT targeting couples where both members were non‐adherent with colorectal cancer screening recommendations demonstrated no difference in uptake of colorectal cancer screening in individuals following receipt of a couple‐tailored booklet versus an individually focused booklet (Manne et al ., 2013).…”